“By now, corporate medicine has milked about all the ‘efficiency’ it can out of the system. With mergers and streamlining, it has pushed the productivity numbers about as far as they can go. But one resource that seems endless and free is the professional ethic of medical staff members,” said Dr. Danielle Ofri, an author and physician at Bellevue Hospital and New York University, from a New York Times guest editorial on June 9, 2019, “Is Exploiting Doctors the Business Plan?”
We are fortunate, within my immediate and extended family, to have the benefit of several medical professionals. My sister, Tanya, is a Nurse Practitioner, my god-daughter, Dr. Martha Cohen-Slade is an ObGyn and a close family cousin has not only been a career long operating room nurse, but also served as Chair of its global professional association, the Association of peri-Operative Registered Nurses, AORN. Their career experience and insights have helped form my opinions on the status of the industry.
My god-daughter, who also just became a new mother, delivered five babies the same day her own labor was later induced before giving birth to her first son. My sister, who has worked all over the country while continuing her own medical studies as well as serving as an educator and nursing faculty member, routinely works through holiday weekends, continuous 30-hour shifts and in both private and hospital based practices, always delivering beyond the call and assigned ‘hours’ of her paycheck.
As I have also often seen these behaviors in many of my own medical advisors and professionals, I can only assume it to be part of the work ethic and ‘patient needs first’ ingrained during years of study and preparation for a career in health care. Hopefully, this aspect of the profession will continue forward, but not to the longterm detriment of the practitioners.
Patients, particularly in an in-patient setting, are generally sicker these days. Greater severity and complexity of chronic conditions, more over-lapping illnesses or infections to treat, as well as more medications to handle, manage and assess for side effects or treating at cross-purposes. And yet the average length of time treatment spent with each patient is expected to be shrinking, or remain the same, aided by technology and that particularly vexing plus/minus of the Electronic Medical Record (EMR).
The EMR is now omni-present and ‘tunneled-in’ to nearly every aspect of the medical system, and though few would wish a return to the pounds-heavy paper charts and copies, the EMR is now remotely accessible 24/7, awaiting updates, notes and provider input, and many providers are now doing just that, using evening, weekend and sleep-hours, off the clock, to update and re-check EMR charts. The average provider/physician spends roughly two-hours of EMR maintenance/updates time per each hour of actual face to face patient care.
Hospitals and provider employers also know this, and in effect consider this a benefit of employing well-paid and ethically driven professionals. But all of this ‘no-down time’ doesn’t add up to everything remaining just fine. Health care professional burn-out is an increasingly real threat to their own health as well as ongoing performance. And despite doctor and nursing shortages nationwide, which increasingly require HB1 Visas and U.S. health care employers to recruit and import medical professionals from other nations, domestic medical and nursing school slots remain in tight supply, while a significant number of Baby Boomer era providers are fast approaching retirement. In addition to the higher error levels one might associate with long-term fatigue, clinical depression and suicide rates among physicians and nurses are now also significantly surpassing those of the general population they care for.
I am no fan of a single payer, government-based health care system. I don’t have to look any further than our troubled Veteran’s Administration system to see what happens when a bureaucracy manages all the keys to the kingdom. But with all the great minds and innovation present in American health care, still considered the world leader in numerous arenas, there simply has to be a better way.
From 1975 to 2010, the number of health care ‘administrators’ within both the for-profit and nonprofit medical sectors, has increased by 3,200 percent. If we considered converting back less than half that personnel hike towards clinical care and more direct patient support, we might be well on our way to closing the provider service gap, as well as better recognizing that the priority should remain getting and keeping patients well, versus processing piles and piles of electronic records and yes, still more paperwork. Hospitals, heal thyself.